Memphis Medical News - Cracking Down on Medicare Fraud:  HHS-OIG Scrutinizing Billing Practices in West Tennessee

For more information on the DOJ/DHHS Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative that includes Medicare Fraud Strike Force teams, visit stopmedicarefraud.gov.  12/2010

Adopted Resolution No. 312 (Tennessee A)

Telemarketing of Durable Medical Equipment
Introduced by the Tennessee Chapter

              WHEREAS, The telemarketing of durable medical equipment (DME) via television and facsimile is growing in both frequency and intensity, and
                  WHEREAS, the requests from vendors to our member physicians for orders and/or approval of certain DME for diabetics, ostomy patients, or mobility impaired persons often is not requested by the patient and the physician, and
                  WHEREAS, the solicitation for orders comes to the provider with identifying information of the patient without any distinction as to the source of the request (supplier vs. the patient), and
                  WHEREAS, the unsolicited request comes to the provider via electronic media (usually fax) and not at the time of an office visit, and
                  WHEREAS, the time to clarify the validity of the request is an unpaid administrative burden, and
                  WHEREAS, the recipient may not qualify for the specified DME because they do not meet criteria for immobility, testing frequency, or appropriate use, and
                  WHEREAS, guidelines, rules and regulations for approval and appropriate use of DME (specifically, electric powered chairs and diabetic testing supplies) are not well known by many of our members, especially as it relates to fraud, now, therefore, be it

RESOLVED, That the American Academy of Family Physicians (AAFP) educate its members with information and guidelines addressing the rules and regulations for appropriate certification of durable medical equipment (DME) solicited on behalf of any patient in their practice in order to comply with regulations and avoid fraud, and be it further

RESOLVED, That the American Academy of Family Physicians (AAFP) recommend a strategy for its members to handle unsolicited requests from vendors for durable medical equipment (DME) or supplies for which recipients may not qualify and may not have requested, and be it further

RESOLVED, That the American Academy of Family Physicians (AAFP) develop a policy statement to address the issue of unsolicited requests from vendors for durable medical equipment or supplies for which recipients may not qualify or may not have requested to use for future reference, and be it further

RESOLVED, That the American Academy of Family Physicians (AAFP) provide a link on the AAFP website explaining exactly how a member can report suspected abuse or fraud by a durable medical equipment (DME) vendor.